Provider Demographics
NPI:1063693687
Name:TATE, JOE DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:DAVID
Last Name:TATE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-0117
Mailing Address - Country:US
Mailing Address - Phone:940-433-2710
Mailing Address - Fax:940-433-2710
Practice Address - Street 1:403 E ROCK ISLAND
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023-3066
Practice Address - Country:US
Practice Address - Phone:940-433-2710
Practice Address - Fax:940-433-2710
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor